Black Women’s Health Care In Crisis

Earlier this month, McAllen and Beaumont, rural border towns in Texas, saw the closure of two more clinics that provide a full spectrum of women’s health care needs, including abortion. Because of Texas’s cruel new law, known as HB 2, people all across the state (and in neighboring states) are rapidly losing access to basic care. That’s two more clinics that can no longer provide Pap smears, cancer screenings, abortions, and birth control to their community—a community that disproportionately consists of low-income women of color who have no other options. It is expected that come September, only six clinics providing reproductive health care, including abortion, will remain. That’s down from 44 in 2011. But this shouldn’t surprise anyone – it’s the predictable consequence of an agenda that kicks the most vulnerable in our nation to the curb. It’s the outcome that forces women to use Coke and Lysol as douches. It’s the outcome of legislation that refuses to offer basic compassion and care to those who need it most. Which begs the question: What happened to the care in our health care system?

“Our country has a long and egregious history of denying women of color the ability to make our own decisions about sexuality and parenting,” says Elizabeth Dawes Gay, a native Texan and reproductive and maternal health expert. Gay, a senior associate at Reproductive Health Technologies Project continues, “It’s imperative that we move past policies that punish women and on to policies that support reproductive decision making, whatever those decisions may be.”

The Whole Woman’s Health clinic in Beaumont was the only comprehensive reproductive health provider between Houston and Louisiana, serving a tight knit, family community, many of whom have lived there for generations. The provider at the clinic is one “who not only performs safe abortions, but has delivered up to three generations of babies for over 40 percent of the city’s population,” explained Marva Sadler, Director of Clinical Services at Whole Woman’s Health. Over 20 percent of the Beaumont population lives below the poverty level— this makes the 200 miles round trip for two separate visits for an abortion prohibitively expensive for far too many women. “Reliable transportation, gas, lodging, and food are only some of the barriers these women will be faced with,” said Sadler, noting that women would also no longer be able to see a provider they could relate to and trust.

Over the years, the number of policies that put up barriers to basic bodily autonomy, deny the support needed to raise a family, and systematically bar low-income people from access to preventive care have increased dramatically. These policies, and the people behind them, effectively refuse preventive care and shame families for seeking out support. Don’t all people deserve to have safe and joyous sex, even if they are poor?

“Legislative leadership is out of step with the vast majority of Texans who support contraception and safe abortion care,” said Amy Hagstrom Miller, President and CEO of Whole Woman’s Health. And she’s right. It’s time that our country stop using “damned if you do, damned if you don’t” policies to shame women about their reproductive health. We aren’t giving women the tools to have safe sex, and when they are faced with an unintended pregnancy, we push the option to terminate the pregnancy out of reach. This is all while we refuse to adequately fund the foster care system, reject policies for quality education and safe neighborhoods, and make raising a child extremely difficult.

We know that the unjust policies within our health care system disproportionately impact low-income women of color who tend to have less access to primary care providers and reliable, affordable contraception. Because Black women don’t have consistent and affordable access to reproductive health care like contraception, we have the highest rate of unintended pregnancies.

Right now, 25 percent of Black women are living below the federal poverty level. Through the Affordable Care Act’s state exchanges and Medicaid expansion programs, advocates hoped to increase the number of families with health insurance, but many are still battling state governments who refuse to accept the federal dollars to cover the expansion over the next ten years. This means low-income families (often households headed by women) who barely make enough to survive but are still above the federal poverty level are squeezed between making too much for Medicaid benefits and too little to afford private insurance. But even if women are lucky enough to qualify for health insurance, where do they go for care?

One in seven women of reproductive age use the Medical program for health insurance. Sadly, even if a woman is eligible for Medicaid or the expansion program, she is still denied access to health care that honors all of her possible decisions. Policies like the Hyde Amendment, an annual budget rider that withholds the use of federal funds for abortion care, force those who need an abortion to pay out of pocket. Abortion care can cost anywhere from $300 to well into the thousands. It can take weeks to raise that kind of money, especially since over 60 percent of women seeking abortion care are already raising a child and 40 percent of women seeking an abortion are already living below the federal poverty level. Policies like the Hyde Amendment take away the decision of how and when to become a parent and force families to continue pregnancies they can’t afford.

The vast majority of Americans believe that everyone should have access to affordable, competent health care. Over 75 percent of African Americans believe that abortion should be covered by health insurance, and 71 percent believe that health care professionals in the community should provide safe, legal abortion services. When our policies refuse to cover abortion care, we perpetuate the stigma that it isn’t health care women want, need, or are deserving of. One in three women will have an abortion during her lifetime. It is a normal part of a woman’s reproductive experience.

This is made worse by the fact that last November, Congress cut Supplemental Nutrition Assistance Program (SNAP) benefits…again. It is unconscionable to ask a mother who is already having a hard time making ends meet to raise another child on $1.40 per meal. Not to mention that nineteen states refuse to provide support for additional children to mothers who were already utilizing Temporary Assistance for Needy Families, a public assistance program, when they become pregnant. Families are now being asked to feed their families with less. It isn’t right. If our society is going to force women who experience unintended pregnancies to continue them, shouldn’t we support her as she cares for them? Are these children not our future too?

When we refuse Medicaid coverage of abortion, women may be forced to carry an unintended pregnancy to term. A 2012 study shows that when women are denied an abortion, they are three times more likely to live in poverty and experience increased negative health outcomes for their children. No matter how we personally feel about abortion, it is not our place to make the decision for someone else. We should not condemn women and families to live in poverty in order to push a political agenda. At the same time, we must commit ourselves to providing a real safety net for those who choose to parent – a net without shame, stigma, or alienation.

Everyone, at every income, should have access to the information, tools, and care necessary to enjoy safe sex, have healthy bodies, and decide when and how to become a parent. We can and should use the resources this country has to meet the needs of women and families and create healthy communities. “This isn’t just about Texas, it’s a national crisis,” says Elizabeth Dawes Gay. The way a nation responds to a crisis and shows compassion towards its most vulnerable says a lot about its priorities. As evidenced by our denial of care, it’s clear; our nation is not making Black women and our health a priority.

Renee Bracey Sherman is a reproductive justice activist and writer with Echoing Ida, a Black Women’s writing collective through Strong Families, and a graduate student at Cornell University pursuing a Master’s in Public Administration. Follow Renee on Twitter @RBraceySherman